The impact of ancillary HIV services on engagement in medical care in New York City.

The advent of antiretroviral therapies in 1996 prompted an interest in the role played by ancillary services in improving access to and retention in medical care, particularly since the success of the new therapies is often contingent upon ongoing and appropriate primary medical care. Using self-reported survey data from a longitudinal representative sample of 577 HIV-positive adults in New York City, this paper explores the impact of such supportive services as drug treatment, case management, housing assistance, mental health treatment and transportation on engagement with medical care. The study's principal finding was that specific ancillary services were significantly associated with an increase in an individual's likelihood of entering medical care and maintaining appropriate medical care services for HIV, particularly when the services addressed a corresponding need.

Risk factors for excess mortality in Harlem. Findings from the Harlem Household Survey.

INTRODUCTION: In 1980, age-adjusted mortality rates in Central Harlem were the highest among New York City's 30 health districts. This population-based study was designed to describe the self-reported frequency of selected health conditions, behavioral risk factors, preventive health practices, and drug use in the Harlem community. METHODS: From 1992 to 1994, in-person interviews were conducted among 695 adults aged 18 to 65 years who were randomly selected from dwelling-unit enumeration lists for the Central Harlem health district. Descriptive statistics were computed for men and women separately, and compared to other population-based surveys. RESULTS: Self-reported medical insurance coverage in Harlem was unexpectedly high (74% of men, 86% of women) as was lifetime use of preventive health practices, e.g., blood cholesterol screening (58% of men, 70% of women). However, lifetime rates of substance use, e.g. crack cocaine (14%) and self-reported history of traumatic events, e.g., witnessing someone seriously injured or violently killed (49% of men, 21% of women) were also high in Harlem, especially in comparison to other populations. CONCLUSIONS: This study has identified important patterns of similarities and differences in risk behaviors between Harlem and other populations. Potential solutions to the health problems of Harlem may lie in the creation of strategies that operate at the community, municipal, and regional level, as well as at the level of individual behavior and risk-taking.

Delivering HIV/AIDS services: the professional care provider speaks out.

BACKGROUND: This study evaluates the stresses and satisfactions experienced by health care and social service providers working in HIV/AIDS service agencies in New York City. This study was part of the Ryan White Title I Evaluation in New York City. METHODS: This study is based on semi-structured interviews with 86 randomly sampled providers from a representative sample of 29 HIV/AIDS service agencies. Personal interviews were completed with a cross section of AIDS care providers. All staff interviewed were audiotaped to facilitate data analysis. Staff discussed their frustrations and their personal satisfaction at working in AIDS care. In addition, all staff completed the Maslach Burnout Inventory (MBI) to facilitate a structured comparison of their levels of burnout. RESULTS: Using the three subscales of the MBI, we found that interviewed AIDS care providers experienced lower than expected levels of burnout. Compared to national norms, health care and social service providers showed above-average levels of personal accomplishment, below-average levels of depersonalization, and average levels of emotional exhaustion. Interview transcripts were analyzed focusing on three broad themes: unique stressors of HIV/AIDS services, positive aspects of HIV/AIDS services, and effective provider supports. The study confirms that HIV/AIDS care providers feel a high level of personal commitment to working with HIV-positive clients. Personal commitment to HIV-positive clients may blunt some of the stresses associated with HIV/AIDS care.

Communes and changing family norms: marriage and life-style choice among former members of communal groups.

This article examines attitudes and behaviors regarding marriage, parenting, and lifestyle among former members of communal groups. A follow-up sample of 635 individuals who lived in a variety of communes in the early 1970s was restudied using personal interviews and self-administered questionnaires. Excommune members are less likely to have married than others in their age group. Sizable proportions currently live in multi-adult households. The vast majority of respondents holds open the possibility of collective living some time in the future. Attitudes show continunity of ideological criticisms of traditional life styles and a commitment to emotional openness and negotiated role relations within the family. Findings support a cohort-historical explanation of the commune movement. Communal experimentation was both a manifestation of and a contributor to the larger process of family change.